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Publications

Breaking through the mind-body divide: patient priorities for interoception research

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Lydia J. Hickman*, Gabriel Mackie*, Beth F. Longley, Hannah S. Savage, Emily Bagley, Hugo Fleming, Rachel Knight, Isabel Lau, Annalise Whines, Sarah N. Garfinkel*, Camilla L. Nord*

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Background: Interoception—sensation, interpretation, and prediction of bodily signals—is reliably disrupted across a wide range of mental health conditions. A growing body of evidence suggests that interoception is a putative mechanism, or ‘active ingredient’, of effective psychological and pharmacological treatments. Anecdotally, patients with psychiatric disorders report differences in bodily experiences. However, formal priority setting by people with lived experience of mental health conditions has so far been overlooked in this rapidly expanding research area.


Methods: This article takes a mixed-methods approach to investigate experiences of bodily signals in individuals with mental health conditions and determine patients' research priorities. We recruited two UK samples in the context of an in-person workshop (N = 25) and online (N = 47), between April and July 2024. All contributors had a diagnosis of at least one mental health condition. Using a combination of written contributions and small group discussions, we explored the most relevant bodily sensations for patients’ mental health, how bodily sensations were experienced by patients, and which research priorities were considered most important.


Findings: Patients’ contributions emphasised the multimodal nature of interoception, in particular the importance of less frequently studied modalities such as the stomach and muscle tension, as well as the need to consider the causes and consequences of distressing bodily sensations. We summarise ten key research priorities for patients, spanning three themes: causes, management, and clinical/research approach to interoception in mental health. These priorities include investigating the impact of bodily signals on social contexts, techniques to manage distressing signals, and a shift of approach towards integrating mental and physical health in clinical/research settings.


Interpretation: Together, this broad scoping study establishes new, transdiagnostic, patient-led priorities for the developing field of interoception in psychiatry to ensure future research focusses on the areas of greatest impact for people with mental health conditions.

Rumble Recognition: a gastrointestinal sound discrimination task to measure gastrointestinal interoception

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Hannah S. Savage, Hugo D. Critchley, Lydia J. Hickman, Beth F. Longley, Wilson P. H. Lim, Edwin S. Dalmaijer, Camilla L. Nord*, Sarah N. Garfinkel*

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Gastrointestinal interoception is the sensing, interpretation and integration of signals originating from the gut. In contrast to chemosensory aspects of gut-brain signalling, perceptual aspects of gastrointestinal viscerosensation and visceromotor control have received relatively little attention despite clear links to physical and mental health and wellbeing. To facilitate research into these aspects of interoception, we developed a novel gastrointestinal sound discrimination task, Rumble Recognition, to measure gastrointestinal interoceptive accuracy, self-beliefs, and metacognitive insight in three ecologically valid conditions; following a 3 hour fast, after drinking sparkling water, and after consuming a high-protein meal replacement shake. The discrimination task used a two-interval forced choice design to assess gastrointestinal interoceptive performance accuracy alongside self-reported confidence from which a measure of metacognitive insight was computed. This novel task was tested for proof-of-principle in a healthy sample (n=45; 68% women), and demonstrated its feasibility, tolerability, and ability to yield parameters relevant naturalistic experiences including reported experience of hunger. The task is fully automated, requires minimal, affordable equipment, and written in freely available via open source code. We anticipate this task can facilitate research in this important, expanding and clinically relevant domain.

The Staircase Heartbeat Discrimination Task (S-HDT)

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Hannah S. Savage, Beth F. Longley, Wilson P. H. Lim, Camilla L. Nord, James Kilner*, Sarah N. Garfinkel*

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Cardiac interoceptive accuracy has received significant attention in the growing field of interoception. Despite this, there are clear, and openly discussed limitations to the tasks commonly used to assess this dimension, including questionable construct validity, unjustified assumptions, and that, depending on the task, few participants exceed chance performance. To address this, we propose a novel version of the heartbeat discrimination task. The Staircase-Heartbeat Discrimination Task (S-HDT) addresses the aforementioned limitations and facilitates a more nuanced understanding of individual differences in cardiac interoceptive accuracy. Herein we (i) detail the experimental null, (ii) demonstrate the recoverability of known point of subjective simultaneity and accuracy values by passing simulated data through our analysis pipeline and (iii) highlight the feasibility and tolerability of this task in a young control sample (n = 42; mean age = 22.57 +/- 4.55; 64.28% women). In our sample, we show the S-HDT has greater sensitivity and specificity than the original HDT, and enables the prediction of accuracy as well as individuals point of subjective simultaneity. With a running time of ~30 minutes, fully automated, open source, and freely available code (via GitHub), this task is accessible to further our understanding of cardiac interoception across multiple interoceptive domains.

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